June 2013 Case of the Month courtesy of Annalee Baker

An 83yo male, h/o HTN, DM, gout, presented to the ED with left leg swelling and pain for 3 days.  He was admitted one month prior for left knee swelling, aspirations revealed urate and calcium pyrophosphate crystals, with a negative culture.  He was treated with steroids and colchicine and discharged to subacute rehab.  He was improving until three days prior to arrival when he worsening pain and edema of the entire extremity.  A bedside ultrasound of the extremity revealed the following:

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The video above demonstrates a DVT in the left common femoral vein, starting at the junction of the saphenous vein extending down the leg to the popliteal vein.    Notice that the vessel is non-compressible with hyperechoic material within the lumen.

The patient was admitted to the Medicine service and anticoagulated with Heparin.  He was also treated for another acute gout flare.